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. 2022 Dec 5;4(2):119-126.
doi: 10.1016/j.hroo.2022.11.006. eCollection 2023 Feb.

Short-term and long-term effects of noninvasive cardiac radioablation for ventricular tachycardia: A single-center case series

Won Ick Chang  1 , Ha Hye Jo  2 , Myung-Jin Cha  2 , Ji Hyun Chang  1 , Chang Heon Choi  1 , Hak Jae Kim  1 , Seil Oh  3 , Clifford G Robinson  4 , Phillip S Cuculich  5
Affiliations

Short-term and long-term effects of noninvasive cardiac radioablation for ventricular tachycardia: A single-center case series

Won Ick Chang et al. Heart Rhythm O2. .

Abstract

Background: Noninvasive cardiac radioablation is reported to be effective and safe for the treatment of ventricular tachycardia (VT).

Objective: This study aimed to analyze the acute and long-term effects of VT radioablation.

Methods: Patients with intractable VT or premature ventricular contraction (PVC)-induced cardiomyopathy were included in this study and treated using a single-fraction 25-Gy dose of cardiac radioablation. To quantitatively analyze the acute response after treatment, continuous electrocardiography monitoring was performed from 24 hours before to 48 hours after irradiation and at the 1-month follow-up. Long-term clinical safety and efficacy were assessed 1-year follow-up.

Results: From 2019 to 2020, 6 patients were treated with radioablation for ischemic VT (n = 3), nonischemic VT (n = 2), or PVC-induced cardiomyopathy (n = 1). In the short-term assessment, the total burden of ventricular beats decreased by 49% within 24 hours after radioablation and further decreased by 70% at 1 month. The VT component decreased earlier and more dramatically than the PVC component (decreased by 91% and 57% at 1 month, respectively). In the long-term assessment, 5 patients showed complete (n = 3) or partial (n = 2) remission of ventricular arrhythmias. One patient showed recurrence at 10 months, which was successfully suppressed with medical treatment. The posttreatment PVC coupling interval was prolonged (+38 ms at 1 month). Ischemic VT burden decreased more markedly than nonischemic VT burden after radioablation.

Conclusion: In this small case series of 6 patients, without a comparison group, cardiac radioablation appeared to decrease the intractable VT burden. A therapeutic effect was apparent within 1-2 days after treatment but was variable by etiology of cardiomyopathy.

Keywords: Cardiac radioablation; Early antiarrhythmic effect; Electrophysiologic change; Safety; Ventricular tachycardia.

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Figures

Figure 1
Figure 1
The relative changes in the total number of ventricular beats (A) and premature ventricular contraction (PVC) and ventricular tachycardia (VT) burden (B) from the pre-radiotherapy (RT) day. C: The changes in composition of ventricular beats after cardiac radioablation. D: The relative change in duration of the longest VT run in all patients from the pre-RT day. Data are presented as mean ± SD.
Figure 2
Figure 2
A: The relative change in the rate of ventricular tachycardia (VT) from the pre-radiotherapy (RT) day. B: Representative example of discontinuation of VT after cardiac radioablation. Data are presented as mean ± SD.
Figure 3
Figure 3
A: The absolute change in coupling interval in all patients from the pre-radiotherapy (RT) day. B: The relative change in coupling interval in each patient from the pre-RT day. C: Representative image of temporal changes in coupling interval. (D) The relative change in coupling intervals in good responders and poor responders from the pre-RT day.
Figure 4
Figure 4
The changes in left ventricular ejection fraction (LVEF) during follow-up after cardiac radioablation. RT = radiotherapy.
See this image and copyright information in PMC

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